§ 27-53.1-8 Notice of transfer.
NOTICE OF TRANSFER
IMPORTANT: THIS NOTICE AFFECTS YOUR CONTRACT RIGHTS. PLEASEREAD IT CAREFULLY.
Transfer of Policy
The [ABC Insurance Company] has agreed to replaceus as your insurer under [insert policy/certificate name and number]effective [insert date]. The [ABC Insurance Company's]principal place of business is [insert address] and certain financialinformation concerning both companies is attached, including (1) ratings forthe last five years, if available, or for any lesser period as is availablefrom two nationally recognized insurance rating services; (2) balance sheetsfor the previous three (3) years, if available, or for any lesser period as isavailable and as of the date of the most recent quarterly statement; (3) a copyof the management's discussion and analysis that was filed as a supplement tothe previous year's annual statement; and (4) an explanation of the reason forthe transfer. You may obtain additional information concerning [ABCInsurance Company] from reference materials in your local library or bycontacting your insurance Commissioner at [insert address and phonenumber].
The [ABC Insurance company] is licensed to writethis coverage in your state. The Commissioner of Insurance in your state hasreviewed the potential effect of the proposed transaction, and has approved thetransaction.
Your Rights
You may choose to consent to or reject the transfer of yourpolicy to [ABC Insurance Company]. If you want your policytransferred, you may notify us in writing by signing and returning the enclosedpre-addressed, postage-paid card or by writing to us at:
[Insert name, address and facsimile number of contactperson.]
Payment of your premium to the assuming company will alsoconstitute acceptance of the transaction. However, a method will be provided toallow you to pay the premium while reserving the right to reject the transfer.
If you reject the transfer, you may keep your policy with usor exercise any option under your policy. If we do not receive a writtenrejection you will, as a matter of law, have consented to the transfer.However, before this consent is final you will be provided a second notice ofthe transfer twenty-four (24) months from now. After the second notice isprovided, you will have one month to reply. If you have paid your premium tothe [ABC Insurance Company], without reserving your right to rejectthe transfer, you will not receive a second notice.
Effect of Transfer.
If you accept this transfer, [ABC InsuranceCompany] will be your insurer. It will have direct responsibility to youfor the payment of all claims, benefits and for all other policy obligations.We will no longer have any obligations to you.
If you accept this transfer, you should make all premiumpayments and claims submissions to [ABC Insurance Company] and directall questions to [ABC Insurance Company].
If you have any further questions about this agreement, youmay contact [XYZ Insurance] or [ABC Insurance].
Sincerely,
XYZ Insurance Company ABC Insurance Company
111 No Street 222 No Street
Smithville, USA Jonesville, USA
555/555-5555 333/333-3333
For your convenience, we have enclosed a pre-addressedpostage-paid response card. Please take time now to read the enclosed noticeand complete and return the response card to us.
[Notice Date]
RESPONSE CARD
]]]]]]]] Yes, I accept the transfer of my policy from[name of transferring company] to [name of assumingcompany].
]]]]]]]] No. I reject the proposed transfer of my policyfrom [name of transferring company] to [name of assumingcompany] and wish to retain my policy with [name of transferringcompany].
]]]]]]]]]]]]]]]]]]
DATE SIGNATURE
Name:
Street Address:
City, State, Zip: